AxSpA: Higher comorbidity burden worsens radiographic progression

A recent study indicated that patients with radiographic axial spondyloarthritis (axSpA) and multiple comorbidities experience significantly greater radiographic progression. This highlights the need for targeted management in patients with a high comorbidity burden.

“Comorbidity is important to our patients. We know that it is associated with higher disease activity, lower quality-of-life, and has a negative influence on treatment response,” said Dr Sizheng Steven Zhao (University of Manchester, UK) [1].

The current registry study aimed to explore whether a higher comorbidity burden also correlates with increased radiographic damage in patients with radiographic axSpA. Data was derived from the Australo-Anglo-American Spondyloarthritis Consortium (TASC). Comorbidity burden was quantified by counting 22 common conditions, including cardiovascular diseases (e.g. hypertension and heart failure), cancer, osteoporosis, and depression. Radiographs were evaluated using a modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) system.

“We divided the participants at baseline into 4 groups, those with no, 1, 2, or ≥3 comorbidities,” Dr Zhao said. Changes in mSASSS over time were related to the comorbidity count at baseline. Analyses were adjusted for the following baseline covariates: mSASSS, sex, symptom duration, C-reactive protein level, TNF inhibitor use, extra-musculoskeletal manifestations, and smoking status. The analysis included 1,150 participants, predominantly men (75%), with a mean age of 44 years, and a median follow-up of 2 years. Comorbidities were present in 73% of the cohort, with a median of 1 comorbidity per participant.

Radiographic progression (measured by mSASSS) was more pronounced with increasing comorbidity burden. Whereas those with 1 comorbidity showed no significant change in mSASSS (-0.2 units over 10 years), those with 2 comorbidities (2.7 units/10 years) and ³3 comorbidities (2.3 units/10 years) exhibited significant increases. This association was not driven by any specific comorbidity.

Thus, Dr Zhao concluded that comorbidity burden is independently associated with greater radiographic progression in axSpA. Moreover, comorbidity is also associated with higher baseline radiographic damage. Therefore, patients with a high comorbidity burden may benefit from targeted management. Future research should explore which conditions contribute most to the observed association and elucidate the underlying causal mechanisms.

1. Zhao SS, et al. Comorbidity burden and radiographic progression in axial spondylarthritis. OP0103, EULAR 2024 Congress, 12–15 June, Vienna, Austria.

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Posted on 29 July 2024